Blood Thinners & Dental Procedures

This section is dedicated to the latest information on oral health topics, culled from authoritative sources such as the American Dental Association.

Click here for the latest news from the American Dental Association.


Heart Disease

Poor dental hygiene can cause a host of problems outside your mouth-including your heart. Medical research has uncovered a definitive link between heart disease and certain kinds of oral infections such as periodontal disease. Some have even suggested that gum disease may be as dangerous as or more dangerous than other factors such as tobacco use. A condition called chronic periodontitis, or persistent gum disease, has been linked to cardiovascular problems by medical researchers.

In short, infections and harmful bacteria in your mouth can spread through the bloodstream to your liver, which produces harmful proteins that can lead to systemic cardiac problems. That's why it is critical to practice good oral hygiene to keep infections at bay-this includes a daily regimen of brushing, flossing and rinsing.


Antibiotic Prophylaxis

In some cases, patients with compromised immune systems or who fear an infection from a dental procedure may take antibiotics before visiting the dentist.

It is possible for bacteria from your mouth to enter your bloodstream during a dental procedure in which tissues are cut or bleeding occurs. A healthy immune system will normally fight such bacteria before they result in an infection. However, certain cardiovascular conditions in patients with weakened hearts could be at risk for an infection or heart muscle inflammation (bacterial endocarditis) resulting from a dental procedure.

Patients with heart conditions (including weakened heart valves) are strongly advised to inform our office before undergoing any dental procedure. The proper antibiotic will prevent any unnecessary complications.


Dentistry Health Care That Works: Tobacco

The American Dental Association has long been a leader in the battle against tobacco-related disease, working to educate the public about the dangers inherent in tobacco use and encouraging dentists to help their patients break the cycle of addiction. The Association has continually strengthened and updated its tobacco policies as new scientific information has become available.

Smoking and Implants

Recent studies have shown that there is a direct link between oral tissue and bones loss and smoking. Tooth loss and edentulism are more common in smokers than in non-smokers. In addition, people who smoke are more likely to develop severe periodontal disease.

The formation of deep mucosal pockets with inflammation of the peri-implant mucosa around dental implants is called peri-implantitis. Smokers treated with dental implants have a greater risk of developing peri-implantitis. This condition can lead to increased resorption of peri-implant bone. If left untreated, peri-implantitis can lead to implant failure. In a recent international study, smokers showed a higher score in bleeding index with greater peri-implant pocket depth and radiographically discernible bone resorption around the implant, particularly in the maxilla.

Many studies have shown that smoking can lead to higher rates of dental implant failure. In general, smoking cessation usually leads to improved periodontal health and a patient’s chance for successful implant acceptance.


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Blood thinners.Millions of people regularly take anticoagulant or antiplatelet medications (sometimes called “blood thinners”) to help prevent heart attack and stroke, and to manage a variety of medical conditions including cardiac arrhythmia and stent placement. While these drugs have proven, life-saving benefits, they can also cause side effects such as increased bleeding. So it may be a cause for concern if you're taking one of them and you need to have a dental procedure.

Anticoagulants are among the more widely used pharmaceuticals today, particularly for heart patients. Some common prescription anticoagulants include heparin, warfarin (Coumadin and generics), clopidogrel (Plavix) and dabigatran etexilate (Pradaxa). Regular aspirin and NSAIDS (like Advil) also have anticoagulant properties. The purpose of anticoagulant medications is to keep the blood from clotting (clumping together) as readily as it normally does; this reduces the chance of a clot forming inside a blood vessel, which could lead to a stroke or heart attack.

If you are taking one or more of these medications, it will take longer for any type of bleeding to stop. For some dental or surgical procedures, that's a factor that must be considered. The most important thing you should do is inform your dentist right away if you are taking any kind of anticoagulant or antiplatelet medication — especially if you have just started taking it. The name and dosage of your medication will be noted in your records, and your cardiologist (or other specialist) will be consulted if necessary, to determine what's best for you.

Having Dental Work with Blood Thinners

While each patient is different, there are some generally accepted guidelines for having dental work while taking anticoagulant medications. If the drug is being taken on a temporary basis (after knee replacement, for example) then the safest choice might be to put off non-essential dental procedures. However, in many cases it's entirely possible to have needed work done while taking anticoagulants. In each situation, the risk of increased bleeding must be balanced against the chance that going off the medication could cause more serious problems.

A number of studies have shown that for many common dental procedures — cleanings, fillings and restorations, for example — it's safer to continue taking anticoagulant medications than to stop, even temporarily. That's because it is generally possible to control bleeding with local measures (such as biting down on gauze), using hemostatic devices and minimally invasive surgical techniques. Scheduling dental work for early in the day and allowing plenty of time for rest afterwards also provides an opportunity to control any bleeding that does occur.

More Complex Procedures

In some cases, more extensive dental procedures such as tooth extraction or implant placement may be recommended for people taking anticoagulants. As always, the potential risks and benefits of stopping the anticoagulant medication must be carefully weighed. To help in the decision-making process, one or more diagnostic blood tests, such as prothrombin time (PT) or International Normalized Ratio (INR), may be ordered. Then a judgment can be made, based on the test results and on clinical experience.

While it's extremely rare for common dental procedures to cause potentially life-threatening complications, it makes sense to take as few chances as possible. That's why you should tell us about any medications you may be taking, including herbs and vitamins. While taking anticoagulants doesn't prevent you from having dental work, it's important to share information about your medications so you can get the best results from your treatment.

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Oral Surgery and Blood Thinners - Dear Doctor Magazine

Oral Surgery & Blood Thinners If you are taking blood thinners — including aspirin — it's important to let your dentist know. These medications (also called anticoagulants) prevent the blood from clotting normally and therefore can make bleeding during dental procedures more difficult to control. However, precautions can usually be taken so that needed procedures can still go forward... Read Article